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Section 9
Compulsive Buying Disorder Part II: Assessment

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The patient’s history forms the most important basis for diagnosing a compulsive buying disorder.[ 23] The initial goal is to define the buying problem through relatively non-intrusive inquiries, and then move on to specific shopping behaviors and patterns. For general screening purposes, a clinician might ask:

• Do you feel overly preoccupied with shopping and spending?
• Do you ever feel that your shopping behavior is excessive, inappropriate or uncontrolled?
• Have your shopping desires, urges, fantasies or behaviors ever been overly time consuming, caused you to feel upset or guilty, or led to serious problems in your life (e.g. financial or legal problems, relationship loss)?

Positive responses should be followed by more detailed inquiries about the shopping and spending behavior, such as how frequently the behavior occurs, what the individual prefers to buy, and how much money is spent.

It is important to carefully assess the patient’s psychiatric history because research has shown that most individuals with compulsive buying disorder have comorbid psychiatric disorders. The presence of comorbidity may suggest particular treatment strategies or approaches, as well as suggest explanations for excessive spending and shopping that may be helpful in counseling patients.

A patient’s history of physical illness, surgical procedures, drug allergies and medical treatment is important, as it may help rule out medical illness as an explanation for compulsive buying (e.g. neurological disorders, brain tumors) or conditions that may contraindicate the use of certain medications prescribed for the disorder. Bipolar disorder should be ruled out because many individuals with the disorder exhibit excessive shopping and spending during manic episodes.

In evaluating the individual, normal shopping and spending behavior must be distinguished from compulsive buying, although it may sometimes be difficult to draw a clear distinction. The clinician must be aware of the inherent differences in shopping behavior of typical men and women, and understand that shopping and spending generally occurs within a cultural context. In American culture, shopping is typically viewed from a female perspective, a fact not lost on advertisers, who aim their advertisements mainly at women. Additionally, persons may go through periods when their shopping and spending behavior may take on a compulsive quality, for example, around special holidays and birthdays. Persons who receive an inheritance or win a lottery may experience spending sprees or binges as well. As with any disorder, the clinician needs to exercise judgment in applying the diagnostic criteria, and must be mindful of the need for evidence of distress or impairment before making the diagnosis.

Screening Instruments
Several groups of researchers have developed instruments to help identify and diagnose this disorder. Working in Canada, Valence et al.[10] developed the Compulsive Buying Measurement Scale. They selected 16 items thought to represent 4 basic dimensions of compulsive buying (the tendency to spend, feeling an urge to buy or shop, post-purchase guilt, and family environment). A reliability analysis based on initial results led the investigators to delete 3 items representing family environment. A modified version of the scale containing 16 items, each rated on a 4-point scale, was tested by German researchers.[11] Their Addictive Buying Indicator (ABI) was found to have high reliability and construct validity. Like the Canadian instrument,[ 10] the ABI was found to discriminate normal from compulsive buying behavior.

These efforts led Faber and O’Guinn[12] to develop the Compulsive Buying Scale (CBS), an instrument expressly designed to identify individuals who exhibit compulsive buying. They began their effort with 29 items based on the earlier work; each item (rated on a 5-point scale) was chosen because it reflected important characteristics of compulsive buying. Using logistic regression, 7 items representing specific behaviors, motivations and feelings associated with compulsive buying were found to correctly classify approximately 88% of the individuals tested. The scale is now considered an important tool by researchers in identifying and diagnosing compulsive buying.

Christenson et al.[18] have developed the Minnesota Impulsive Disorder Interview (MIDI), which is used to assess the presence of compulsive buying, kleptomania, trichotillomania, intermittent explosive disorder, pathological gambling, compulsive sexual behavior and compulsive exercise. The diagnostic instrument is fully structured and designed for use in research settings. The section on compulsive buying consists of 4 core questions and 5 follow-up questions. The developers recommend administering their 82-question expanded module to persons screening positive for compulsive buying. Lejoyeux et al.[24] have developed a questionnaire consisting of 19 items which tap the basic features of compulsive buying. These dimensions include:

• impulsivity
• urges to shop and buy
• emotions felt before, during and after purchasing
• post-purchase guilt and regret
• degree of engagement of short termgratification
• tangible consequences of buying
• avoidant strategies.

Its psychometric properties have not been reported. Monahan and colleagues[25] modified the Yale- Brown Obsessive-Compulsive Scale (YBOCS) to create the YBOCS-shopping version (YBOCS-SV) to assess cognitions and behaviors associated with compulsive buying. The authors conclude that their scale is reliable and valid in measuring severity and change during clinical trials. Like its parent instrument, The YBOCS-SV consists of 10 items, 5 which rate preoccupations and 5 which rate behaviors. For assessing both preoccupations and behaviors, individuals are asked about time involved, interference due to the preoccupations or behaviors, distress associated with shopping, the resistance to the thoughts or behaviors, and the degree of control over the symptoms. In the sample described by Monahan et al.,[25] the mean YBOCS-SV score for individuals thought to have compulsive buying was 21 (range 18 to 25) compared with 4 (range 1 to 7) for unaffected individuals.
- Black, DW; Compulsive buying disorder: definition, assessment, epidemiology; and clinical management; CNS Drugs; 2001; Vol. 15; Issue 1.

Personal Reflection Exercise #2
The preceding section contained information about the assessment of compulsive buying disorder.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 9
What must the clinician be aware of when evaluating the shopping habits of a potential compulsive buyer? To select and enter your answer go to CEU Test.

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